CPT 59425 vs 59426: OB/GYN Antepartum Care Only Billing Guide

Sirius solutions global
8 hours ago
5 min read

SIRIUS Solutions Global slide on CPT 59425 vs 59426 OB/GYN billing, with smiling doctor examining a pregnant patient beside ultrasound.

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4-6 vs 7+

Visit Count Splits 59425 From 59426

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Why Antepartum-Only Coding Creates Payment Delays

Not every OB/GYN practice manages a pregnancy from confirmation through delivery. Patients relocate, transfer care, or occasionally the pregnancy doesn't reach delivery under the same provider. When that happens, billing the global maternity package is incorrect — and the two codes built for exactly this situation, CPT 59425 and 59426, get mixed up more often than most maternity codes.

Our OB/GYN billing experts at Sirius Solutions Global see the same pattern across antepartum-only claims: the visit count is right, but the code doesn't match it, or the practice tries to bill a global package for care it didn't fully provide. This 2026 guide breaks down exactly when CPT 59425 applies, when 59426 applies, and the documentation that keeps these claims from getting denied.

CPT 59425 vs CPT 59426 Quick Comparison

CPT Code	Description	Antepartum Visits	When to Use	Common Billing Mistake
59425	Antepartum care only	4-6 visits	Provider furnished 4-6 visits, didn't complete the OB package	Billed alongside 1-3 individual E/M visits for the same pregnancy
59426	Antepartum care only	7 or more visits	Provider furnished 7+ visits, didn't complete the OB package	Billed for fewer than 7 visits, or combined with 59425

What Is Antepartum Care Only Billing?

Antepartum care only billing applies when a provider furnishes routine prenatal visits but does not also perform the delivery or postpartum care for that pregnancy — commonly because the patient relocates, transfers to another practice, changes insurance mid-pregnancy, or the pregnancy doesn't reach delivery under that provider's care. In these situations, the global maternity codes (like 59400 or 59610) don't apply, since those require the same provider or group to manage antepartum, delivery, and postpartum care together. CPT 59425 and 59426 exist specifically to bill the antepartum portion on its own.

CPT 59425 Explained

CPT 59425 reports antepartum care only when the provider furnished 4 to 6 routine prenatal visits before care ended under that provider — whether due to relocation, transfer, or the pregnancy not continuing under their care.

☐ Reported once, as a single unit, regardless of the exact visit count within the 4-6 range

☐ Should not be billed alongside individual E/M visit codes for the same pregnancy

☐ Should not be billed together with 59426 for the same episode of care

☐ The initial confirmatory pregnancy visit is generally excluded from the visit count

☐ Requires an appropriate pregnancy-related ICD-10 diagnosis to support medical necessity

CPT 59426 Explained

CPT 59426 reports antepartum care only when the provider furnished 7 or more routine prenatal visits without completing the delivery or postpartum care — sometimes called a "mini global" antepartum code.

☐ Reported once, as a single unit, regardless of how many visits beyond 7 were provided

☐ Should not be used for fewer than 7 visits — that falls to 59425 or individual E/M codes instead

☐ Covers only routine prenatal visits; problem-focused visits unrelated to routine care (like treating a UTI) are billed separately with the appropriate E/M code

☐ A physician who provided all antepartum care but was not present for delivery (for example, emergency delivery by another provider) still reports 59426 for their antepartum visits

CPT 59425 vs 59426: Key Differences

Visit Count	Correct Billing Approach
1-3 visits	Bill each visit individually using the appropriate E/M code (99202-99215) — not 59425
4-6 visits	Bill CPT 59425 once, as a single unit
7 or more visits	Bill CPT 59426 once, as a single unit, regardless of the exact count above 7

Documentation Requirements for Antepartum Care Only Claims

☐ Total number of antepartum visits provided under this practice's care

☐ Reason care ended under this provider — relocation, transfer, insurance change, or non-continuation

☐ Pregnancy-related ICD-10 diagnosis (O00-O9A range or appropriate Z34 supervision code)

☐ Clinical notes for each visit: vitals, fetal assessment, and counseling documentation

☐ Confirmation that no delivery or postpartum care was provided by this practice

Common OB/GYN Billing Errors That Cause Denials

Antepartum Care Billing Checklist for OB/GYN Practices

☐ Confirm delivery and postpartum care were not provided by this practice

☐ Count only routine prenatal visits toward the 4-6 or 7+ threshold

☐ Exclude the initial confirmatory visit from the visit count

☐ Select 59425, 59426, or individual E/M codes based on the exact count

☐ Attach an appropriate pregnancy-related ICD-10 diagnosis

☐ Do not append modifier 52

☐ Bill the code once, as a single unit, not once per visit

How Medical Billing Companies Improve OB/GYN Revenue Cycle Management

Sirius Solutions Global supports OB/GYN practices with coding accuracy review, claim scrubbing before submission, denial management, eligibility verification, and revenue cycle optimization — built around the specific complexity of split-care maternity billing and antepartum-only scenarios.

Explore our full OB/GYN billing services → siriussolutionsglobal.com/specialties/ob-gyn-billing

Frequently Asked Questions — Antepartum Care Only Billing

▼ Q: What is CPT 59425 used for?

CPT 59425 reports antepartum care only when a provider furnished 4 to 6 routine prenatal visits without also providing the delivery or postpartum care for that pregnancy.

▼ Q: How many visits are included in CPT 59426?

CPT 59426 covers 7 or more antepartum visits, billed once as a single unit regardless of the exact count above 7.

▼ Q: Can CPT 59425 and CPT 59426 be billed together?

No. Each represents a distinct visit range for the same episode of antepartum-only care, and only one applies based on the actual number of visits provided.

▼ Q: What documentation supports antepartum care only billing?

Documentation should show the total visit count, the reason care ended under this provider, a pregnancy-related ICD-10 diagnosis, and confirmation that delivery and postpartum care were not provided by this practice.

▼ Q: Why are OB/GYN claims denied for maternity billing?

Common causes include billing a global package when care was actually split between providers, miscounting antepartum visits, using the wrong code for the visit count, and including problem-focused visits that should be billed separately.

▼ Q: Does CPT 59425 or 59426 require a modifier?

Generally no. These codes already represent a defined portion of the global package, so modifier 52 (reduced services) is not needed and may be inappropriate to append.

▼ Q: What's the difference between 1-3 visits and 4-6 visits billing?

For 1-3 antepartum visits, each visit is billed individually with the appropriate E/M code. Once a provider reaches 4 visits, billing shifts to CPT 59425 (or 59426 at 7+), reported once as a single unit rather than per visit.

Final Thoughts

CPT 59425 and 59426 solve a specific problem: billing accurately when a provider furnishes real, ongoing prenatal care but doesn't complete the full maternity package. Getting the visit count right, avoiding unnecessary modifiers, and documenting why care ended under that provider are what keep these claims moving cleanly through payer review.

Need help reducing OB/GYN billing errors and improving reimbursement accuracy? Connect with Sirius Solutions Global for expert medical billing support.

⚠️ Important Disclaimer

Disclaimer

This article is intended for educational purposes and should not replace official CPT guidelines, payer policies, or professional coding advice.

This content reflects AMA CPT guidance and general payer billing principles understood to be current as of 2026. Visit-count thresholds, modifier requirements, and split-billing rules vary by payer and plan — always verify current requirements with the specific payer before submitting a claim.

Coding decisions should be based on the complete medical record and reviewed by a certified professional coder (CPC) or compliance officer before claims are submitted.